A conversation with Janice Bremis

Janice is the founding member of the Eating Disorders Resource Center. She was diagnosed with an eating disorder in 1975, and is well aware of the stigma associated with the disease, as well as the importance of emotional support and access to quality treatment. The Eating Disorders Resource Center (EDRC) is a non-profit organization that links resources, information and support for eating disorders in Silicon Valley. The main aim of EDRC is to increase awareness and understanding of eating disorders for the general public and for health professionals; to promote early diagnosis, effective treatment, and recovery; and to advocate for mental health parity legislation and effective insurance coverage. EDRC responds to calls and emails from patients, family members, clinics and health care professionals requesting support and information, treatment options, and help with navigating the health care and insurance systems. 

Janice has healthcare through disability from medical issues resulting from her eating disorder. Because she is on disability, Janice gets government provided Medicare. Janice believes she is extremely lucky; her main healthcare provider is Stanford, which accepts Medicare. She notes, however, that for many others, finding a treatment provider that will take Medicare is nearly impossible. This is because the reimbursement Medicare provides is so low, only a fraction of medical treatment cost. In the interview, she notes the work that the Eating Disorder Coalition has been doing in getting treatment access and nutrition counseling to those with Medicare.

When I asked Janice about the average cost for eating disorder treatment, I was absolutely shocked when she said it could cost hundreds of thousands of dollars without insurance. The overall cost depends on the severity, the type, and length of the eating disorder, but Janice put it in perspective, eating disorders are no more expensive than caring with someone with Leukemia. Both are serious and life threatening illnesses though there is a stigma around eating disorders that it's a phase or they can just snap out of it. This same stigma is carried into the healthcare realm. Many believe that if there is no tangible evidence, there is not a medical problem. This mentality has led to the disparities for physical and mental health funding.

Janice has also found that race, socioeconomic status, age, and ethnicity play a role in whether or not you get mental health treatment. Because insurance coverage is often done on a case by case basis, a higher percentage of the Hispanic and African American populations are being denied eating disorder treatment because insurance companies believe they don't fit the eating disorder demographic. This case by case basis also means that people must advocate for themselves and the treatment they need. Insurance companies rarely approve treatment on the first go; getting treatment covered involves lots of phone calls, meetings, and doctors appointments which can be almost as time consuming as a full time job. Many of those who need to work do not have time to make their case to the insurance companies and never end up getting treatment. Those who do not need to work are usually able to wear the insurance companies down and get some sort of subsidized treatment though not always ideal.

In general, Black and Hispanics have less access to healthcare; a large part of this is due to the fact that America's system of health insurance is linked to employment. Janice is an avid believer that this should not be the case. Besides employment based insurance preventing a good portion of the population from getting decent medical care, it creates a phenomena where people choose their profession or stay in jobs they don't enjoy in order to get medical care. Janice is a strong believer in healthcare being accessible to all. She believes that if the federal government extended healthcare coverage to all Americans like what's happening in other countries, many more people could get the care they need. She proposes insurance based on age or income are both better ways to approach healthcare distribution. Janice says that she would be willing to contribute $100 of her $2000 monthly income so that healthcare could be universal.